Sleep is essential to the maintenance of physical and psychological health. We all know how difficult life can be when we’re not sleeping well. Poor sleep can have a negative impact on your energy levels, mood, performance and enjoyment of life. So it’s worth taking a few minutes to think about how you might be able to improve your quality and quantity of sleep.
The sleep cycle
During sleep our heart rate slows, body temperature falls and the complex changes take place in brain activity. When we first fall asleep we enter the non-rapid eye movement (NREM) stage of sleep. NREM is divided into three stages, with each stage becoming progressively deeper.
NREM1 and NREM2 are light stages of sleep from which we are easily woken. NREM3 is a deeper stage of sleep and some may feel disorientated if woken from this sleep stage. Finally, we move onto stage four which is known as rapid eye movement (REM) sleep. It is during this stage of sleep that people dream. Normal sleep patterns consist of a mix of all the different stages of sleep. According to the Sleep Council, the consumer education arm of the National Bed Federation, a good night’s sleep consists of five or six cycles, whereas disturbed sleep consists of far fewer.
Keeping a sleep diary
Most adults need between six and nine hours of sleep every night. By working out what time you need to wake up, you can set a regular bedtime schedule to help aid a good night’s sleep. The NHS Choices website recommends that people who are struggling to sleep may find that keeping a sleep diary can help. This may help to uncover lifestyle habits that can contribute to insomnia. A typical sleep diary may include answers to some of the following questions:-
- what are your sleeping times
- how long did it take to get to sleep
- did you wake up during the night, and if so, how many times
- did you take any medication to aid sleep
- did you have any stimulants, for example, caffeine and alcohol
- did you exercise shortly before bed?
If you do go to your GP or a sleep expert for more help with sleeping they may ask you to keep a sleep diary to aid their diagnosis of your sleep problem. For further information, see the NHS Choices website.
People for whom sleep problems are a regular occurrence and are interfering with their daily life, may be suffering from a sleep disorder. Anybody who is unsure as to whether they have a sleep disorder can take the Epworth sleepiness scale test. For further information about the test, see the Narcolepsy UK website.
Continued poor sleep can affect the brain’s function and lead to problems such as forgetfulness, irritability or lack of concentration. Over a prolonged period the part of the brain that controls language, memory, planning and sense of time is severely affected. So sleep is crucial to feeling good and enjoying life. Given that insomnia is often caused by lifestyle choices, here are some tips that might help to improve your sleep:-
- keep a regular routine, go to bed at the same time and get up at the same time, but don’t go to bed until you feel tired
- don’t eat a heavy meal late in the evening, this can lead to heartburn and difficulty in falling asleep, opt for something light, for example, wholemeal toast or a bowl of cereal
- don’t drink caffeine late in the day, instead switch to decaffeinated drinks after 4pm (caffeine stays in your system longer than you might think)
- the NHS recommends at least 150 minutes of moderate aerobic exercise/activity plus two or more strength sessions per week. However, strenuous exercise late in the evening will stimulate the body so if you have problems sleeping you might find that a more calming exercise, such as Yoga or Tai Chi, works better for you
- keep your bedroom dark, cool (if necessary, leave a window slightly open), clean, clutter-free and quiet (wear soft ear plugs if needed)
- keep your bed for sleep, reading, listening to relaxation music and sex. The mind and body will then create a positive association between these things and the bed
- if you are not asleep within 30 minutes get up and do something relaxing, but not stimulating, until you feel tired and ready to go back to bed. Try to be relaxed about it, don’t clock watch and your natural sleep rhythm should soon return
- ensure that you have a good bed and pillow that is comfortable and suits your need
- make sure that your bedding is appropriate for the time of year, for example, lightweight in the summer and heavy in the winter.
Some prescription and over-the-counter medication can cause insomnia as a side effect. These include:-
- some antidepressants
- epilepsy medicines
- medicines for high blood pressure, for example, beta blockers
- steroid medication
- non-steroidal anti-inflammatory drugs (NSAIDS)
- some asthma medicines.
People should check with their GP or local pharmacist to see if any medication they are taking could cause insomnia or sleeping difficulties.
Restless legs syndrome (RLS)
Restless legs syndrome, also known as Willis-Ekbom disease, is a medical disorder that causes an urge to move your legs (this can also affect some people’s arms). This urge develops when sufferers are lying down or resting and is usually caused by uncomfortable, tingly or aching sensations. This sensation is often worse in the evenings and during the night, so it is most commonly associated with difficulty in sleeping.
Common signs and symptoms include:-
- uncomfortable sensations deep within the legs, accompanied by a strong urge to move them
- repetitive cramping or twitching of the legs during sleep
- these sensations are triggered by rest and often get worse at night.
Sufferers often find that the discomfort eases when they move, stretch or massage their legs. In some instances, restless legs syndrome is linked to an underlying medical condition, for example, iron deficiency or kidney disease. In instances where it is not related to an underlying medical condition, sufferers might find that regular exercise, good sleep habits and quitting smoking may help. For further information and support, see the RLS-UK, the restless legs syndrome charity website.
Obstructive sleep apnoea (OSA) is a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. These pauses in breathing interrupt the sufferer’s sleep and whilst people rarely remember the interruptions, they can often feel exhausted, tired and irritable during the day. Symptoms of sleep apnoea include:-
- chronic snoring
- gasping, snorting or choking whilst asleep
- waking up with shortness of breath, chest pains, headaches, nasal congestion, or a dry throat
- frequent pauses in breathing during sleep.
Sleep apnoea is a serious condition and anybody who suspects that they may have sleep apnoea should consult their doctor. Treatment options include:-
- lifestyle changes, such as losing weight, cutting down on alcohol and sleeping on your side
- using a continuous positive airway pressure (CPAP) device. This device delivers air via a mask during sleep
- using a mandibular advancement device (MAD) which is a gum shield-like device that fits around the teeth, holding the jaw and tongue forward to increase space at the back of the throat whilst sleeping.
For further information about sleep apnoea, including advice about treatment, see the British Snoring and Sleep Aponoea Association website.
Narcolepsy is a sleep disorder that causes people to fall asleep very suddenly at inappropriate times. It is caused by a malfunction of the brain mechanism that controls sleeping and waking. People who have narcolepsy may have sleep attacks at any time, for example, whilst working, talking or driving. Symptoms include:-
- excessive daytime sleepiness
- disturbed night-time sleep
- sleep attacks – falling asleep suddenly and without warning
- cataplexy- the temporary loss of muscle control, often in response to emotions, for example, laughter and anger
- sleep paralysis- temporary inability to move or speak when falling asleep or waking up.
For more information, including the diagnosis and treatment of narcolepsy, see the Narcolepsy Association UK (UKAN) website.
Sleep and mental health
Conditions such as depression, anxiety and stress commonly cause insomnia and sleep disturbances. Equally, people who suffer from a severe sleep problem over a long period of time can go on to develop a mental health problem. Often, people with long-term sleep problems can develop unhelpful thoughts and associations with sleep that make the problem worse.
In these instances cognitive behavioural therapy (CBT) can help people to change negative patterns of thinking and behaviour. CBT, also known as a talking therapy, can be offered for a range of sleep problems.
The Mind website has advice about how to deal with sleep problems that are related to mental health conditions, for example, anxiety and depression. For further information, see the Mind website.
Accessing NHS therapy services
The NHS England Improving Access to Psychological Therapies (IAPT) programme is designed to help people to access therapy easily. Anyone who needs therapy, such as counselling, can access it through their GP, workplace, educational establishment or voluntary and charitable organisations. Ordinarily, this service is free to NHS users and GPs should be aware of what is available to patients in their local area and also make the necessary referral.
For people who prefer not to go through their GP, some services have a self-referral option which enables you to go directly to a professional therapist. To search for local psychological therapy services, see the NHS Choices website.
Availability of services can vary and NHS therapy in some parts of England, in particular rural areas or small towns, can be very limited. Equally, people may have to wait a long time or travel some distance to find something suitable.
If you live in Wales or Scotland, please visit Health in Wales or NHS Scotland for information about services.
Pharmacist Support’s Listening Friends telephone helpline is staffed by trained volunteers and provides callers with the opportunity to talk anonymously and in confidence to a pharmacist about any stresses they are facing in their work or home life. You can contact our Listening Friends Helpline on 0808 168 5133, or you could contact our enquiry line on 0808 168 2233.
Other useful information
Regional UK sleep clinics
Sleep centres can help with the diagnosis and management of sleep disorders. People will need a referral from their GP in order to access an NHS sleep clinic. For a full list of sleep clinics/centres in the UK, see the Narcolepsy UK website.
YoungMinds is a charity committed to improving the emotional wellbeing and mental health of children and young people. Parents who are worried about their child’s sleeping habits can call the YoungMinds Parents’ Helpline on 0808 802 5544, or for further information, see the YoungMinds website.
The Sleep Council has a series of nodcasts featuring soothing sounds to help you off to sleep at night. These include birdsong and the sound of the sea. For further information, see the Sleep Council website.